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Changes to quality and compliance visits for nursing homes

The quality of residential aged care services (nursing homes) featured in the news again in 2017. Failures of care identified at the Oakden Older Persons Mental Health Service in Adelaide led the Australian Government to commission an independent review of aged care quality regulation known as the Carnell review.

Against this background, the Government has announced two changes to quality and compliance visits made to nursing homes by assessors from the Australian Aged Care Quality Agency (the Quality Agency). The first change is a result of a 2015–16 Budget measure to expand cost recovery arrangements for the Quality Agency, and the second is a direct response to a recommendation of the Carnell review.

The current system of visits

All nursing homes must be accredited by the Quality Agency in order to receive Australian Government funding. There are four Accreditation Standards (with a total of 44 outcomes) covering management, health and personal care, lifestyle and the physical environment. The Quality Agency undertakes three main types of visits to assess nursing homes’ performance against these standards:

review audits where there are concerns that a service may not be complying with the standards and

assessment contacts including at least one unannounced (spot check) visit to each service per year.

Nursing homes to be charged for spot check visits

Currently, providers pay an accreditation fee for each nursing home, which includes the cost of a site audit for re-accreditation, but do not pay for annual unannounced visits. The Government announced in the 2015–16 Budget that it would move to full cost recovery for accreditation activities. This included increasing the accreditation fee (implemented in May 2017) and introducing a new charge for annual unannounced visits.

The Government intends to start charging for unannounced visits from 1 July 2018, subject to the passage of legislation. Providers will pay an annual levy of between $2,726 and $5,878, depending on the number of beds in the nursing home. Small providers and those in rural and remote areas or serving homeless clients will receive a discount on the levy. The unannounced visit levy is expected to raise $31.5 million in revenue over three years. There will be no charge for review audits.

Legislation to implement the levy was scheduled for the spring 2017 sittings of Parliament, but was not introduced. The CEO of the Quality Agency told a Senate Estimates hearing in October 2017 that the Government would introduce the bill ‘in due course’. Several aged care provider peak bodies, including Aged & Community Services Australia and Leading Age Services Australia, have expressed opposition to the levy. They are concerned about the additional cost burden on nursing homes, and also concerned that the system may not appear independent if providers pay for compliance visits.

Site audits will no longer be announced in advance

Nursing homes currently receive advance notice when a site audit is scheduled as part of the re-accreditation process. Minister Wyatt announced in October 2017 that the Government will move to make such visits unannounced. This change implements recommendation eight of the Carnell review, which was that re-accreditation visits should be replaced with unannounced visits, with the frequency and rigour of the visits to be determined by a risk-based process.

The Carnell review received evidence that announced site audits could be ‘staged’ to ‘ensure the facility presents itself in the best possible light’, given that nursing homes have three to six months to prepare. The review noted Quality Agency data showing that ‘unannounced site visits are more effective than announced site visits at identifying non-compliance.’ The review acknowledged concerns that unannounced visits can be disruptive for the nursing home, but concluded that the level of disruption was not as great as sometimes suggested.

The Department of Health indicated at an Estimates hearing (p. 146) it expects to be able to implement unannounced site audits without legislative change, most likely through an amendment to the Quality Agency Principles 2013 (a legislative instrument). The accreditation fees will not change. The Quality Agency has not yet announced when this change will take place, but is providing updates on its website.

The removal of notice for site audits is supported by the Australian Labor Party. Aged care consumer peak body COTA Australia similarly supports increasing the number and scope of unannounced visits. Provider peak bodies have reportedly pledged to work with the government on reforms to quality regulation, but are awaiting further detail on how unannounced site audits will be implemented.

More changes to come for aged care quality regulation

The Government indicated in the Mid-Year Economic and Fiscal Outlook 2017–18 that it will respond to the other recommendations of the Carnell review in the 2018–19 Budget. In the meantime, it is pressing ahead with its plan to replace the four sets of standards for residential care, home care, Indigenous flexible care and post-hospital (transition) care with a single set of aged care quality standards. A Bill to provide for a single set of standards is scheduled to be introduced in the current session of Parliament.

The Senate Community Affairs References Committee is currently inquiring into the effectiveness of the Aged Care Quality Assessment and accreditation framework, prompted, like the Carnell review, by the failures of care at Oakden. The Committee released an interim report on 13 February 2018. Following a referral from the Minister for Health and Sport, the House of Representatives Standing Committee on Health, Aged Care and Sport is inquiring into the quality of care in residential aged care facilities in Australia.

The introduction of a provider levy to pay for unannounced annual visits, and the move to make site audits for re-accreditation unannounced as well, appear unlikely to be the last changes to the aged care quality assurance system in 2018.

Note: this article was originally published on 12 February 2018 and updated on 15 February 2018 to include further information.